Provider Demographics
NPI:1275677130
Name:MUNOZ DELGADO, MAYRA NOEMI (MD)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:NOEMI
Last Name:MUNOZ DELGADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 CENTRALIA CT STE 102
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3759
Mailing Address - Country:US
Mailing Address - Phone:352-394-8060
Mailing Address - Fax:352-708-6420
Practice Address - Street 1:8135 CENTRALIA CT STE 102
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3759
Practice Address - Country:US
Practice Address - Phone:352-394-8060
Practice Address - Fax:352-708-6420
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277814900Medicaid
FLAG547VMedicare PIN
FL277814900Medicaid
H45111Medicare UPIN
FLAG547XMedicare PIN
FLAG547WMedicare PIN
FLAG547UMedicare PIN